MANAGEMENT OF RHEUMATOID ARTHRITIS IN ELDERLY PATIENTS

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease that is characterized by polyarthritis, progresses with joint damage, and may involve extra-articular tissue. Although RA can develop at any age, its prevalence increases with age. The number of elderly RA patients is gradually increasing due to both the increase in the frequency of late-onset (age 65 and over) RA (LORA) patients and the increased life expectancy. RA is characterized by inappropriately accelerated immune aging that occurs in the early period and is independent of disease duration. Aging can affect both the onset and the clinical phenotype of RA. Moreover, one of the most challenging issues for specialists is the treatment of RA in elderly patients. Targeted treatment of RA in elderly patients is inadequate or not optimally administered due to patients’ pre-existing comorbidities, polypharmacy, physicians’ concerns about possible drug side effects, and the lack of specific treatment guidelines for elderly RA patients. Elderly RA patients have been rarely and sometimes not even included in randomized controlled trials due to both age and comorbidities. Nevertheless, evidence for the safety and efficacy of specific RA treatments in the elderly population is gradually increasing. In elderly patients with RA, disease activity, all the comorbidities of the patient, and possible side effects of the drugs should be taken into consideration when making treatment decisions, and the treatment target should be individualized. In this review, the epidemiology of elderly RA patients, their comorbidities, briefly immune aging in RA, and the medical treatment approach in elderly RA will be discussed in light of studies.